We all knew that late in the dry season, malnutrition would peak. But this week it hit us hard. Our outreach teams had difficulty coping. The hospital was temporarily over-run. Dr. Johanna, our MSF doctor from Sweden, told me the hospital “looked like a refugee camp”. The team and myself surveyed the hospital grounds. Two patients shared a bed in some circumstances; the area we use for children’s play was covered with mattresses on the ground and patients ; and our tent used for epidemic infectious disease was filled with malnourished children … Quickly, we started making plans to deal with the increased numbers.
Being able to go to the hospital at night requires a proverbial blade, its attachment and a handle. Practically speaking we need drivers, cars, petrol, guards and radio operators to make it happen. We need nurses on duty, who first discover something is wrong. We need logisticians who ensure there are generators to give light to the hospital at night. We need non-medical team members to also order key medications that I or other medics might prescribe at night. We need a coordination team in the capital to reach an agreement with the Ministry of Health that we can work here in Amtiman. And we need donors and supporters who generously give to make all of this possible.
Late at night we need a doctor. But we need a lot more too.
When the plane landed, three of our patients with vesicovaginal fistulas (VVF) emerged. They had been treated in Abeche by the MSF-Switzerland team over the course of many weeks. VVF is a tragic medical problem where there is an abnormal connection between the bladder (or bowel) and vagina. This is often caused by an obstructed labour. Women are divorced, lose their families and are ostracized for this terrible problem. At the MSF-Switzerland “Village des femmes” this problem is surgically repaired and women can recover and gain their strength among other women with the same problem. I am not sure I have seen a more incredibly important and dignity-restoring intervention than MSF’s VVF hospital in Abeche, Chad.
When I sat on the bed across from Hissen, I just looked at him. His serious little face was angry. I fished out my mobile phone and offered it him. He took it carefully with his right hand and held onto it. I kept on giving him more things out of my pockets and he kept taking them only with his right hand. He would not use his left arm at all. After enough temporary gifts, Hissen agreed to shake my hand. Every move I made, he studied me as carefully as I was studying him.
Inspecting his left arm, we could see there was a swelling above his elbow. As gently as I could, I ran my fingers over it. Hissen did not like that. He immediately cried and I had to stop. Something was wrong.
As a doctor, in MSF work and in Canada, family members tap me on the shoulder and ask for my attention all the time. It’s hard to know if it is an emergency or a less serious concern. The man who was looking for his brother was just one of these worried family members the night of this critical event. Everyone who has lost their brother or their sister deserves a helping hand. That is what we are here to do.
But the work we do – and making it happen – is so much more than physically attending to patients. Direct patient care is the sharp end of the scalpel – but much more makes up the rest of the tool.